Thursday, May 10, 2012

Our family sat down together to watch the Budget the other night. (“Isn’t
there anything else on?” asked one of my daughters. Would the politicians give
them fewer nightmares than Doctor Who?) When it got the health parts of the
budget, here is what I thought I heard Wayne Swan say: “Hospitals hospitals
hospitals hospitals hospitals hospitals....”

I’ve skimmed over quite a bit of the budget coverage, but
there isn’t a great deal of commentary on the parts of the budget affecting
Aboriginal and Torres Strait Islander health. Croakeyhas
a good summary and there was some good Twitteropinion.

However, I haven’t seen much other analysis more than just
listing the components, but I think there are some implications that we need to
watch for, so here, for what it’s worth, is my analysis.

Insert disclaimer- I’m not an economist, just a practitioner enjoying
trying to make sense of stuff. My analysis could be very wrong, (I don’t think
it is, though!) but it’s a useful starting point for a discussion. This is also
my opinion – I do work for some organisations who have official opinions on
this, which may or may not coincide with mine!

Overall, the government has increased spending on Indigenous
health – up from $1.032 billion to $1.074billion. The headline figure that the
government has relating to Indigenous health is $5.2 billion, which is a lovely
big sum of money. However, $3.4 billion over 10 years of this is for the
Stronger Futures in the Northern Territory. This also includes $6.4million (it actually says $6.4 but I don’t think that’s what it means!) for preserving AITSISIS
collections and the money for SBS to set up a National Indigenous Free to Air
TV service. (It’s not clear what happens to NITV). Also included in this sum are
a number of projects in local Aboriginal and Torres Strait Islander
communities, that all look very good. For people who don’t live in these
communities though, there’s not a great deal , and there doesn’t seem to be an
overall strategy.

Perhaps an overall strategy is to be found in the “Outcome 8”
Indigenous Health documents from the Department of Health and Aging. This lists
the budget under the Closing the Gap program around preventing chronic disease.
It looks like these haven’t changed much. I don’t see any extra money or new
initiatives there, but neither do I see a stripping out of money, which is
good, given the context of this budget and the promise for a surplus.

There is also $67.9million dollars being cut from health workforce programs in "streamlining" workforce initiatives, with the money going to other government priorities. Given that the workforce dealing with Aboriginal and Torres Strait Islander health is somewhat understaffed, there could be a problem if there is not the workforce o deliver all these marvellous programs.

There is another pattern to be found in this budget,
however. $75 million dollars have been removed from infrastructure projects in
indigenous health. This has been redirected towards the Aboriginal and Torres
Strait Islander Health program and the Health and Hospitals Fund. Given
that this latter fund includes $48.6million
for indigenous health infrastructure in 10 remote communities, this looks like
a funding cut to me. Apparently, DoHA say the money has been taken from low
priority projects, though I don’t imagine they were low priority when the money
was applied for or granted!

In a similar vein, money has been removed from indigenous
literacy projects and redirected into Stronger Futures in the Northern
Territory. While the right noises are made about primary care and education in
the Stronger Futures initiatives, there is a significant amount of opposition
to Stronger Futures in Aboriginal communities, because, once again, it
continues the European tradition of doing to not working with. Stronger Futures
started out as the Northern Territory Emergency Response, then became the
Intervention, then became Closing the Gap in the NT and is now Stronger
Futures. While the government have done more consulting around this, and there
is a wide range of opinions in Aboriginal communities (as you would expect in
any community) you could not argue that there was broad support for the measure
in Aboriginal communities. The problem is that this will undermine the
effectiveness of primary care initiatives and education initiatives done as
part of this. There is clear evidence that real partnerships with Aboriginal
communities are necessary to make progress in this area.

The other potential for a big narrative in this budget is in
the measures for a National Disability Insurance Scheme, the Dental
arrangements and the Aged Care measures. Aboriginal people have twice the rate
of disability as non-indigenous people, and these disabilities occur at a
younger age. There are also well recognised problems with oral health, which
have knock on effects for diabetes and cardiovascular health. So these measures
have great potential to provide support and much needed care for Aboriginal and
Torres Strait Islander people. However, don’t forget that Aboriginal people
have had much less access to Medicare and to the Pharmaceutical Benefits Program,
and it has needed specific measures to address this. I see no reason why the
National Disability Insurance Scheme would be any different with thought put to
this. We will not Close the Gap if 10 years from now we have a lovely NDIS
operating and Aboriginal people are accessing it at half the rate of
non-indigenous people. This needs to be thought about at this stage.

So, I think the budget is a mixed bag for Indigenous Health.
It’s worth checking out the media releases from some other organisations on
their budget reaction, though, because I was surprised to find myself at the
more negative end of the spectrum!

So, as the AMA say, “the devil will be in the detail” and it
is worth watching this space closely to see that this significant investment
gets to where it is needed and is used in the most effective way. I have no
doubt that that will involve partnerships with Aboriginal and Torres Strait
Islander communities, rather than impositions.

I’m looking forward to the day when I hear a treasurer stand
up to present the budget and hear them saying “Primary Care, Primary Care,
Primary Care, Primary Care. Oh. And consultation. Real consultation.”